Initial Hemoconcentration during Hospitalization Is a Prognostic Factor in Patients with Cardiac Type Acute Heart Failure

Introduction: Hemoconcentration (HC) is an important index for decongestion and has been proposed as a prognostic factor in heart failure (HF) patients. We investigated the importance of initial HC during hospitalization focused on the difference between cardiac type HF and vascular type HF. Methods: We enrolled 209 consecutive acute decompensated HF inpatients classified as Nohria/Stevenson wet&warm (78 years, 118 females). HC was defined as the elevation of hemoglobin after initial 3 days therapy. Vascular type of HF was simply defined as systolic blood pressure ≥140 mmHg at initial visit and Cardiac type as 90–140 mmHg. All patients were divided into 4 groups: Vascular type with HC (n = 62), Vascular type without HC (n = 63), Cardiac type with HC (n = 40) and Cardiac type without HC (n = 44). All patients were followed up to 180 days. Cardiac-event was defined as cardiac death and re-hospitalization for worsening heart failure. Results: The mean of ejection fraction was 43% and plasma brain natriuretic peptide level was 1,132 pg/mL. In Kaplan-Meier survival analysis, the cardiac-event rate in Cardiac type without HC was significantly higher than that in any other groups (Log-rank P = .001). Adjusted multivariate analysis identified Cardiac type without HC as an independent predictor of cardiac-events (HR: 2.43; 95%CI: 1.36–4.38; P = .003). Conclusion: Initial HC during hospitalization is a prognostic factor in cardiac type acute HF patients.